lymphocytic tumours ofthe conjunctiva · other tumours. lymphoblasts may be seen in-filtrating the...
TRANSCRIPT
J. clin. Path., 1971, 24, 585-595
Lymphocytic tumours of the conjunctivaGWYN MORGAN
From the Department ofPathology, Institute of Ophthalmology, London
SYNOPSIS Twenty-six cases of lymphocytic tumour of the conjunctiva, which were originallyclassified as benign lymphoma and lymphosarcoma, were followed up for more than five years,They were then reclassified into non-disseminating and disseminating groups. Only when germinalfollicles are present can a histological diagnosis of benign lymphoma be made. Moreover, it is onlywhen lymphoblasts are seen to be infiltrating the tissues that a definitive diagnosis of lymphosar-coma can be made. The remaining tumours, which represent the large majority of lesions, show a
very similar or identical histological picture, and a diagnosis of benignity or malignancy can onlybe made after a prolonged follow up. The possible nature of the non-disseminating lymphocytictumours is briefly discussed.
Lymphocytic tumours of the conjunctiva are usuallyclassified as lymphoma or benign lymphoma,lymphosarcoma, or lymphatic leukaemic deposits.With the exception of the latter, which in most casescan be readily diagnosed haematologically, thisclassification presents some difficulties because thehistological diagnosis on initial biopsy is sometimesbelied by the subsequent clinical course. Thus atumour diagnosed 'benign' may later disseminateand conversely a 'malignant' tumour may not. Eitherthe original diagnosis was in error or there is nosharp histological distinction between benignity andmalignancy in this group of tumours.
In order to examine these difficulties and todetermine to what extent histological features canbe correlated with the subsequent clinical course, Icarried out a long-term follow-up of these cases oflymphocytic tumour of the conjunctiva (excludingleukaemic deposits). On the record of their clinicalbehaviour for a period of more than five years, theywere reclassified into non-disseminating and dis-seminating tumours and the original clinical andhistological features reviewed retrospectively inorder to discover any features that might havepointed to their subsequent course.Examples of 'benign lymphoma' have been recor-
ded by many authors. Hochheim (1900) described awoman of 79 years with bilateral tumours. Othercases have been recorded by van Duyse (1905) whowas the first worker to treat the lesions by irradia-tion, Baslini (1907), Cosmettatos (1910), and CoatsReceived for publication 12 November 1970.
(1915) who described five cases affecting youngpeople. The tumours recorded by Coats wereslowly growing and were situated at the inner portionof the conjunctiva, three affecting the plica, one thecaruncle, and the fifth affecting the limbus. Thelesions were bilateral and symmetrical in one case.Bedell (1922) described the first case in America, andother cases have been described by Speciale-Picciche (1927), Saradarian (1940), Ayoub (1948),Svoboda (1948), Magni (1949), King and Ashton(1949), Blaxter (1955), Friedman, Borrelli, andGeleris (1955), Charamis (1957), Valvo (1959),Scuderi and Cardia (1959), Lerman (1960), Trzcinska-D4browska (1963), Fronimopoulos, Kofinas, andLambrou (1964), and Buiuc, Cordun, Be~chea,Popovici, and Rinea (1966).Examples of 'Iymphosarcoma' of the conjunctiva
have been recorded by Vollaro (1899), Werner (1904),Fergus (1905), Goldzieher (1907), and Teulieres (1910)who described a lesion near the caruncle which wasassociated with cervical lymphadenopathy; Coats(1915), Casolino (1916), Bedell (1922), Shannon andMcAndrews (1932), Ennema (1935), Heath (1949),Roveda (1949), Heritier and Wachtel (1951), Capalbi(1951), Cometta (1952), Junghannes (1953), Schardt(1956), Offret and Rouher (1956), Hilaris, Katrakis,and Karapatakis (1959), Chatterjee (1959), Vancea,Lazarescu, Cerne, and Vaighel (1959), Lerman(1960), and Theodore (1960) who described a patientwith lymphosarcoma of the stomach who developedlesions of both conjunctivae several years later; andby Bernardi, Martuzzi, and Palmieri (1963). The
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Fig. 1 Clinicalphotograph ofthe eye, showing afleshylymphocytic tumour of the conjunctiva.
conjunctival lesions may precede, succeed, or beconcomitant with lesions elsewhere in the body.
Clinically, lymphocytic tumours of the conjunctivaare typically small, firm, salmon pink-coloured,fleshy, slowly growing, and painless lesions that canbe found anywhere in the conjunctiva and mayextend onto the cornea or into the orbit. The lesionsmay be bilateral, occasionally multiple, and usuallyhave a sharply demarcated border, the tumourtending to mould itself to the contour of the sur-rounding structures (Fig. 1).The usual histological appearances are of a sheet
of lymphocytes lying in a delicate fibrovascularstroma (Fig. 2) usually with occasional plasma cells(Fig. 3) and reticulum cells. Germinal follicles (Fig.4) are a feature of some cases, and foci of reticulumcells (Fig. 5), multilobulated reticulum cells (Fig. 6),Russell bodies (Fig. 7), epithelioid cells (Fig. 8), andmitotic figures and fibrosis (Fig. 9) may be seen inother tumours. Lymphoblasts may be seen in-filtrating the conjunctival tissues (Fig. 10) in somecases.
Material
Twenty-six cases of lymphocytic tumour of theconjunctiva were studied and followed up for morethan five years (Table I). The lesions were classifiedinto benign lymphoma and lymphosarcoma and atthe end of five years were classified again into non-disseminating and disseminating lymphocytictumours. The clinical and histological features werethen reviewed in retrospect in order to see whetheror not there were any features that might haveindicated the final outcome.
Fig. 2 Lymphocytic tumour ofthe conjunctiva,composed ofa sheet oflymphocytes and occasionalreticulum cells. H and E x 590.
Results
Of the 26 cases followed up, the initial diagnosis wasbenign lymphoma in 18 cases and lymphosarcoma ineight cases (Table II). The final diagnosis in thegroup of benign lymphomas was 16 non-dissemi-nating tumours and two disseminating tumours. Ofthe eight cases diagnosed as lymphosarcoma, fourdisseminated and four did not (Table III). A reviewof the clinical and histological features of the twocases diagnosed initially as benign lymphoma(cases 14 and 23) and later disseminated as lympho-sarcomas is shown in Table IV. A benign lymphoma(case 4) which did not disseminate is included forcomparison. It will be seen that there were noclinical or histological changes which might havesuggested that these two tumours would havedisseminated as lymphosarcomas. Both cases showedhistological features that were similar or identicalwith case 4 which did not disseminate, the patientbeing alive and well 16 years after the onset. Bothtumours (cases 14 and 23) showed a sheet of lympho-cytes with occasional reticulum cells (Fig. 11).
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Lymphocytic tumours of the conjinctiva
Fig. 3 Lymphocytic tumour of the conjunctiva, Fig. 4 Lymphocytic tumour of the conjunctiva,showing plasma cells near the centre of the field. H and showing a germinalfollicle. H and E x 130.E x S90.
Fig. 5 Lymphocytic tumour of the conjunctiva, showing Fig. 6 Lymphocytic tumour of the conjunctiva,a focus of reticulum cells. H and E x 590. showing two multilobulated reticulum cells (arrows).
H and E x 590.
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Fig. 7 Lymphocytic tumour ofa Russell body near the centre ojH and E x 590.
the conjunctiva, showing Fig. 8 Lymphocytic tumour of the conjunctiva, showingf the field (arrow). a focus of epithelioid cells centrally. H and E x 130.
A~~~~~~~~~~
xg.ite***o;.';
tb . _~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~4
Fig. 9 Lymphocytic tumour of the conjunctiva, showingfibrosis. H and E x 130.
Fig. 10 Lymphocytic tumour (lymphosarcoma) of theconjunctiva, showing many lymphoblasts. H and E x 590.
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589Lymphocytic tumours of the conjunctiva
Case Age Sex Site Relevant Clinical Gross Histopathology Primary Recurrence Follow UpFeatures Appearance Treatment
1 32 M Inner Bilateral lesions Localized A sheet of lymphocytes Excisioncanthus for 12 months, raised mass with occasional(L eye) blood count, reticulum cells
ESR, and WRnormal
2 49 F Lower Recent onset Localized A sheet of lymphocytes Biopsyfornix Similar lesion raised mass with well defined(L eye) excised from R follicles of reticulum
conjunctiva 2 cells, epitheliumyears previously infiltrated
3 63 F Fornices Present 1 month Soft, pink, A sheet of lymphocytes Biopsycaruncle Blood count raised mass with occasional(R eye) normal reticulum cells
No Alive and wellwith no lesions18 years afteronset
Two yearsafter biopsyrecurrenceexcised
Alive and wellwith no lesions15 years afteronset
No Died 11 yearsafter onset fromcoronary occlu-sion. No tumourpresent
4 46 F Lower Present 2 years, Widespread A sheet of lymphocytes Biopsy and No Alive and wellfornix gradual increase raised pinkish with a few plasma cells irradiation without symptomsinner in size tumour and reticulum cells, (300 r) 16 years aftercanthus some of the latter onsetpalpebral being multilobulated(R eye)
5 69 F Upper Present 1 month Localized A sheet of lymphocytes Biopsy Two years and First recurrencefornix with ptosis and mass and occasional three years excised and(L eye) chemosis, blood reticulum cells after onset; second irradiated
count normal second (2900 r in 3-recurrence weeks); patientinvolved orbit alive and well 11
years after onsetwithout symptoms
6 46 F Bulb Present 6 months,Localized A sheet of lymphocytes, Biopsy No Died 5 years(R eye) blood count nodular mass and a few plasma cells, after onset from
normal eosinophils, and pneumonia; noreticulum cells tumour present
7 54 F Lower Present 1 month, Localized A sheet of lymphocytes Biopsy and No Alive and well 12fornix gradual increase raised mass and an occasional irradiation years after onset;(L eye) in size, blood reticulum cell; no evidence of
count normal epithelium infiltrated tumour
8 57 F Palpebral Present 9 months,Localized A sheet of lymphocytes Excision and No Died 4i years(R eye) gradual increase raised mass and occasional plasma irradiation after onset from
in size, blood cells cardiac failurecount and ESR and malignantnormal hypertension; no
tumour present
9 55 F Bulb Present 12(R eye) months, recent
increase in size,blood countnormal
Raised mass A sheet of lymphocytes Excision No Alive and well6 years afteronset; no tumourpresent
10 25 M Inner Present 3 Localized A sheet of lymphocytes Excisioncanthus months, blood raised mass and occasional plasma(R eye) count normal cells; a focus of
epithelioid cells present
11 50 F Bulb Present 4 years Localized A sheet of lymphocytes Excision(L eye) and excised papillary mass with occasional plasma
elsewhere, cells and reticulumrecurred and cells; marked stromalgradual increase fibrosisin size
No Alive and well8 years afteronset; notumour present
4 years after Alive and wellonset 10 years after
onset; no tumourpresent
Table I Clinico-pathological features, primary treatment, andfollow up cases studied
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Case Age Sex Site Relevant Clinical Gross Histopathology Primary Recurrence Follow UpFeatures Appearance Treatment
12 58 M Palpebral Recent onset; Localized A sheet of lvmnho- Biopsv and No Died 1 year(L eye) tonsillectomy raised mass blasts and lymphocytes, irradiation
followed by predominantly theirradiation former; an occasional
reticulum cell andmitoses seen
13 54 M Bulb Present 3 Localized A sheet of lymphocytes Biopsy and No(R eye) months; blood raised mass and a few plasma cells irradiation
count normal and multilobulatedreticulum cells;epithelium andlymphatic vesselsinfiltrated
14 47 M Fornices Recent onset; Localized A sheet of lymphocytes Biopsy and 34 months(L eye) Similar lesion nodular mass and occasional irradiation after onset
in other eye reticulum cells, plasma (1500 r in 32treated by cells and eosinophils; days)irradiation a focus of reticulum(1500 r in 32 cells and a fewdays); blood multilobulatedcount normal reticulum cells present
15 38 M Fornix Present 6 Widespread A sheet of lymphocytes Biopsy and(R eye) months; gradual papillary with occasional irradiation
increase in size; lesion reticulum cells, (3150 r in 38blood count eosinophils, and days)normal; similar mitoseslesion in othereye
16 26 M Bulb Present 8 years; Localized flat A sheet of lymphocytes Excision(R eye) gradual increase lesion with occasional ill-
in size; blood defined foci ofcount normal reticulum cells;
epithelium infiltrated
17 85 F Caruncle Present 2 Localized A sheet of lymphocytes Excision(R eye) months; blood raised lesion with a few reticulum
count normal cells and a few foci ofreticulum cells
18 57 M Fornices Recent onset; Localized A sheet of lymphocytes Biopsy(L eye) gradual increase raised lesion with a few reticulum
in size; blood cells and mitosescount normal;ESR raised to34 mm/hour(Wintrobe);similar lesion inR eye treated byirradiation;cervicallymphadenopathyL side for 2 yearsand irradiated;mediastinallymphadenopathyand R pleuraleffusion for Iyear, biopsy oflymph nodeshowedlymphosarcoma
19 65 M Bulb Present for 18 Localized A sheet of lymphocytes Excision(L eye) months raised lesion and occasional
reticulum cells
No Alive and well7 years afteronset; no tumourpresent
Nil Alive and well13 years afteronset; no tumourpresent
Nil Died 4 yearsafter onset withcongestivecardiac failure;no tumour present
Nil Died 1 year afteronset of con-
junctival lesionsand 3 years aftercervicallymphadenopathyfrom congestivecardiac failure;no conjunctivaltumours present
Nil Died 8 yearsafter onset, withnephritis; notumour present
Table I Clinico-pathological features, primary treatment, and follow up cases studied-continued
590 Gwyn Morgatr
after onset withwidespreadmetastases
Died 5j yearsafter onset froma coronarythrombosis; notumour present
Twenty-twomonths afteronset, enlargedlymph nodes inneck and groinirradiated.Died 5 yearsafter onset withgeneralizedlymphosarcoma
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Case Age Sex Site Relevant Clinical Gross Histopathology Primary Recurrence Follow UpFeatures Appearance Treatment
20 69 M Lower Recent onset; Localizedfornix blood count and raised mass(R eye) ESR normal
21 62 M Lower Recent onset of Localizedfornix lesions of the raised mass(L eye) skin and cervical
lymph nodes
22 58 M Bulb andinnercanthus(R eye)
Gradual onset Localizedover 6 months; raised massblood count andESR normal;lesion on oppositeside recurred 21years and 3 yearsafter excision
A sheet of lymphocytes Biopsywith ill-defined germinalfollicles and occasionalplasma cells andreticulum cells
A sheet of lymphocytes; Biopsy andepithelium infiltrated irradiationsome fibrosis present
A sheet of lymphocytes Excisionwith a few plasma cellsand reticulum cells;infiltration of lymphaticvessels
Nil Alive and well 7years after onset;no tumourpresent
Nil Died 4 yearsafter onset withmetastases in thespleen, liver, andlymph nodes
Six-and-a-half Alive and wellyears after 6* years afteronset onset; residual
bilateral lesionsat both innercanthi
23 51 F Upper Present 2 years Widespreadfornix with ptosis; raised lesion(R eye) blood count and
ESR normal;similar lesion onopposite side
24 40 F Upper Present 4 years; Widespreadfornix and gradual increase raised lesioninner in size; bloodcanthus count and ESR(R eye) normal; similar
lesion in oppositeeye recurred 5years, 6 years, and8 years afteronset, andirradiated
25 50 M Bulb Present 9 Localized(L eye) months; blood papillary
count normal; lesionsimilar lesionin other eyeirradiated;hepatomegalyand inguinallymphadenopathyfor same period
26 50 M Lower Present 5 years; Localizedfornix and blood count and papillarycaruncle ESR normal lesion(R eye)
A sheet of lymphocytes Biopsy andwith a fairly large irradiationnumber of plasma cells,a few Russell bodies,and a few reticulumcells, some of thelatter beingmultilobulated
A sheet of lymphocytes Biopsy andand occasional irradiationreticulum cells (3000 r in 21
days)
A sheet of lymphocyteswith a few reticulumcells
Biopsy andirradiation(750 r in 15days)
A sheet of lymphocytes Excisionwith prominentgerminal follices
Three, 4 and 6 Died 7 years
years after after onset withonset,and meta!tases in thetreated by liver and spleenirradiation
Nil Alive and well 8years after onset,with no evidenceof any tumour
Nil Died 4 years
after onset;lesions in L iliacfossa
Nil Alive and well5i years afteronset
Table I Clinico-pathological features, primary treatment, andfollow up cases studied-continued
Multilobulated reticulum cells were also present included for comparison. It will be seen that there(Fig. 12) and Russell bodies and plasma cells (Fig. were no histological features which might have13) were features of case 23. indicated that case 21 would disseminate and thatA review of the clinical and histological features the other four cases would not, nor was the outcome
of the four cases diagnosed initially as lympho- related to the primary treatment (Table I). Thesarcoma (cases 11, 15, 19, and 24) and did not histological features of case 19 (Fig. 14) are identicaldisseminate is shown in Table V. A tumour which to those of case 21 (Fig. 15), the latter patient dyingwas diagnosed as lymphosarcoma (case 21) and with widespread lymphosarcomatous lesions.which disseminated four years after the onset is A comparison of the 20 cases which were diag-
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Case Initial Diagnosis
1 Benign lymphoma
2 Benign lymphoma
3 Benign lymphoma
4
5
6
Benign lymphoma
Benign lymphoma
Benign lymphoma
7 Benign lymphoma
8 Benign lymphoma
9
10
11
12
Benign lymphoma
Benign lymphoma
Lymphosarcoma
Lymphosarcoma
13 Benign lymphoma
14 Benign lymphoma
15 Lymphosarcoma
16 Benign lymphoma
Follow Up
Alive and well 18years after onsetAlive and well 15years after onsetDied from coronarythrombosis 11 yearsafter onsetAlive and well 16years after onsetAlive and well 11
years after onsetDied from pneu-monia 5 years afteronsetAlive and well 12years after onsetDied from cardiacfailure 4j years afteronsetAlive and well 6years after onsetAlive and well 8years after onsetAlive and well 10
years after onsetDied 1 year afteronset withwidespreadmetastasesDied from coronarythrombosis 5i yearsafter onsetDied fromlymphosarcoma 5years after onsetAlive and well 7years after onsetAlive and well 13years after onset
Final Diagnosis
Non-disseminatingtumourNon-disseminatingtumourNon-disseminatingtumour
Non-disseminatingtumourNon-disseminatingtumourNon-disseminatingtumour
Non-disseminatingtumourNon-disseminatingtumour
Non-disseminatingtumourNon-disseminatingtumourNon-disseminatingtumourDisseminatingtumour
Non-disseminatingtumour
Disseminatingtumour
Non-disseminatingtumourNon-disseminatingtumour
Case Initial Diagnosis
17 Benign lymphoma
18
19
20
21
22
23
24
25
26
Lymphosarcoma
Lymphosarcoma
Benign lymphoma
Lymphosarcoma
Benign lymphoma
Benign lymphoma
Lymphosarcoma
Lymphosarcoma
Benign lymphoma
Follow Up
Died from cardiacfailure 4 years afteronsetDied 1 year afteronsetDied from nephritis8 years after onsetAlive and well 7years after onsetDied 4 years afteronsetAlive and well 61years after onsetDied 7 years afteronsetAlive and well 8years after onsetDied 4 years afteronsetAlive and well 51years after onset
Final Diagnosis
Non-disseminatingtumour
DisseminatingtumourNon-disseminatingtumourNon-disseminatingtumourDisseminatingtumourNon-disseminatingtumourDisseminatingtumourNon-disseminatingtumourDisseminatingtumourNon-disseminatingtumour
Table II Comparison offinal diagnosis with initialdiagnosis after follow up
Initial Diagnosis Final Diagnosis
Non-disseminating DisseminatingTumour Tumour
Benign lymphoma 16 2(18 cases)
Lymphosarcoma 4 4(8 cases)
Table III Summary offinal outcome of the tumours
Case Clinical Features Histopathology
14 Recent onset of localized nodular mass in (L) fornices; A sheet of lymphocytes and occasional reticulum cells, plasmasimilar lesion in other conjunctiva treated by irradiation; cells, and eosinophils; a focus of reticulum cells and a fewblood count normal multilobulated reticulum cells present
23 Widespread, raised lesion in (R) upper fornix for 2 years; A sheet of lymphocytes with a fairly large number of plasmablood count and ESR normal; similar lesion on opposite side cells, a few Russell bodies, and a few reticulum cells, some of
the latter being multilobulated
4 Lesion of (R) lower fornix inner canthus and palpebra A sheet of lymphocytes with a few plasma cells and reticulumconjunctiva for 2 years cells, some of the latter being multilobulated
Table IV Two cases diagnosed as benign lymphoma which disseminated and one not disseminating for comparison
Case Clinical Features Histopathology
11 Localized papillary mass in (L) bulbar conjunctiva for 4 years; lesion A sheet of lymphocytes with occasional plasma cellsrecurred and increased in size gradually and reticulum cells; marked stromal fibrosis
15 Widespread papillary lesion of (R) fornix for 5 months; gradual A sheet of lymphocytes with occasional reticulum cells,increase in size; similar lesion in other eye irradiated; blood count eosinophils, and mitotic figuresnormal
19 Localized raised lesion of (L) bulbar conjunctiva for 18 months A sheet of lymphocytes and occasional reticulum cells
24 A widespread raised lesion of the (R) upper fornix and inner canthus, A sheet of lymphocytes and occasional reticulum cellspresent for 4 years and increasing in size gradually; similar lesion inopposite eye recurred on three occasions; blood count and ESR normal
21 Recent onset of localized raised mass in (L) lower fornix; recent onset A sheet of lymphocytesof lesions in the skin and cervical lymphadenopathy
Table V Four cases diagnosed as lymphosarcoma which did not disseminate and one disseminating for comparison
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Fig. 11 Lymphocytic tumour (lymphosarcoma) of the Fig. 12 Lymphocytic tumour (lymphosarcoma) of theconjunctiva which disseminated, showing a sheet of conjunctiva, showing multilobulated reticulum cells.lymphocytes with occasional reticulum cells. H and E H and E x 590.x 130.
Fig. 13 Lymphocytic tumour (lymphosarcoma) of the Fig. 14 Lymphocytic tumour (benign lymphoma),conjunctiva, showing plasma cells and Russell bodies showing a sheet of lymphocytes. H and E x 80.(arrows). H and E x 590.
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Fig. 15 Lymphocytic tumour (lymphosarcoma) showinga sheet oflymphocytes. H and E x 130.
nosed finally as non-disseminating tumours with thesix cases of disseminating tumour is shown in TableVI. It will be seen that there were no distinguishingclinical features between the two groups. As far as
the six tumours that disseminated are concerned, I
made enquiries about these by letter and can confirmthat none of them showed any abnormal lympho-cytic or lymphoblastic activity in the blood stream.Two tumours (cases 20 and 26) in the non-dissemi-nating group showed germinal follicles which were
not seen in any of the six tumours which dissemi-nated. One tumour that disseminated showedinfiltration of the tissues by lymphoblasts (case 12),a feature which was not seen in any of the non-
disseminating tumours. Apart from these twofeatures, however, there were no histological criteriato suggest a diagnosis of either benign lymphoma orlymphosarcoma.
Discussion
Twenty-six lymphocytic tumours of the conjunctivawere classified into benign lymphoma and lympho-sarcoma on their initial histological appearances.They were followed up for more than five years, andon the basis of their clinical behaviour were re-classified into non-disseminating and disseminatinggroups. Of the 18 'benign' tumours, two metastasizedas lymphosarcomas and of the eight 'malignant'tumours, four did not disseminate. The histologicalfeatures of these two groups are very similar or
identical apart from the fact that one tumour (case12, a lymphosarcoma) showed lymphoblastic in-filtration of the conjunctiva and that germinafollicles were found only in those tumours which didnot disseminate. Apart from these two histologicalfeatures there are no means by which the pathologist
No. of Cases Histology Non-disseminating DisseminatingTumours Tumours
Number of cases 20 6Age 25 yearsto 47 to
85 years 62 yearsSex 9 males/ 5 male/
11 females 1 femaleSite (fornices) 10 4Bilateral cases 5 4Time present when first seen Recent to 8 years Recent to 2
yearsRapid growth of lesion (when recorded) 0 0Slow growth of lesion (when recorded) 7 1Localized growth of lesion (when recorded) 15 5Widespread growth of lesion (when recorded) 3 1Normal blood count (when done) 16 * 6Normal ESR (when done) 6 1Raised ESR (when done) 0 1
Other inflammatory cells present 18 5Multiobulated reticulum cells present 2 2Foci of reticulum cells present 3 1Germinal follicles present 2 0Infiltration of tissues by lymphoblasts 0 1Infiltration of lymphatic vessels by lymphocytes 2 0Infiltration of epithelium by lymphocytes 4 1Mitotic figures 1 2Fibrosis 1 1
Table VI A clinico-pathological comparison of 20 non-disseminating and six disseminating tumours
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can foretell the outcome of these tumours, and aprolonged follow up is necessary in order to arriveat a diagnosis of benignity or malignancy.The nature of these non-disseminating lympho-
cytic tumours is not known. It is possible that theyrepresent lesions of lymphoid hyperplasia due tosome aetiological agent such as a microorganism,chemical injury, or irradiation. The presence ofother inflammatory cells and germinal follicles insome cases support this contention, but no evidenceof any aetiological agent has been demonstrated inany of the reported cases. The other possibility isthat they may be true neoplasms having a very lowdegree of malignant potential, and this suggestion issupported by the fact that they have a similar oridentical histological picture to lymphosarcoma. Ifthey are malignant tumours, however, it is strangethat they do not eventually disseminate even afterprolonged periods of time. At the present momentthe question of their true nature must remainunanswered.
I am most grateful to Professor Norman Ashton forhis advice during the preparation of this article.
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